Reasons for Choosing Conservative Management in Symptomatic Patients With Severe Aortic Stenosis ― Observations From the CURRENT AS Registry ―
- 23 August 2019
- journal article
- research article
- Published by Japanese Circulation Society in Circulation Journal
- Vol. 83 (9), 1944-1953
- https://doi.org/10.1253/circj.cj-19-0247
Abstract
Background: There has not been a previous report on the long-term outcomes of those patients who refuse aortic valve replacement (AVR) despite physicians' recommendations. Methods and Results: Among 3,815 consecutive patients with severe aortic stenosis (AS) enrolled in the CURRENT AS registry, the study population comprised 2,005 symptomatic patients, who were subdivided into 3 groups by their treatment strategy and the reasons for conservative strategy (Initial AVR group: n=905; Patient rejection group: n=256; Physician judgment group, n=844). The primary outcome measure was a composite of aortic valve-related death and heart failure hospitalization. Patients in the patient rejection group as compared with those in the physician judgment group were younger, and had less comorbidities, and lower surgical risk scores. The cumulative 5-year incidence of the primary outcome measure in the patient rejection group was markedly higher than that in the initial AVR group, and was similar to that in the physician judgment group (60.7%, 19.0%, and 66.4%, respectively). Conclusions: Patient rejection was the reason for non-referral to AVR in nearly one-quarter of the symptomatic patients with severe AS who were managed conservatively. The dismal outcome in patients who refused AVR was similar to that in patients who were not referred to AVR based on physician judgment despite less comorbidities and lower surgical risk scores in the former than in the latter.Keywords
This publication has 31 references indexed in Scilit:
- Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major MorbidityCirculation: Cardiovascular Quality and Outcomes, 2012
- Outcome of Patients With Low-Gradient “Severe” Aortic Stenosis and Preserved Ejection FractionJournal of the American College of Cardiology, 2011
- Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation Clinical Trials: A Consensus Report From the Valve Academic Research ConsortiumJournal of Invasive Cardiology, 2011
- Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research ConsortiumEuropean Heart Journal, 2010
- Prognosis of octogenarians with severe aortic valve stenosis at high risk for cardiovascular surgeryPublished by BMJ ,2010
- Risk stratification of patients with aortic stenosisEuropean Heart Journal, 2010
- Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical PracticeJournal of the American Society of Echocardiography, 2009
- Malignant Natural History of Asymptomatic Severe Aortic Stenosis: Benefit of Aortic Valve ReplacementThe Annals of Thoracic Surgery, 2006
- A global clinical measure of fitness and frailty in elderly peopleCMAJ : Canadian Medical Association Journal, 2005
- Predictors of Outcome in Severe, Asymptomatic Aortic StenosisThe New England Journal of Medicine, 2000